CLINICOPATHOLOGICAL ANALYSIS AND THERAPY IN HEPATITIS-C VIRUS-ASSOCIATED NEPHROPATHY

We analyzed the clinicopathological features and therapy in 19 patient s with kidney disease accompanied by hepatitis C viral infection, incl uding 12 patients with mesangial proliferative glomerulonephritis (inc luding eight with IgA nephropathy), six with membranoproliferative glo merulonephritis (MPGN), and one with membranous nephropathy. Persisten t hematuria and/or proteinuria (10 patients) was the most common findi ng, followed by nephrotic syndrome (8 patients). Cryoglobulinemia was detected in six of 19 patients examined (four of six patients with MPG N), Analysis of hepatitis C virus (HCV)-RNA genotype in 13 patients re vealed that nine of them had type II genotype. All four patients with MPGN, who had serum positive for HCV-RNA, had type II genotype. Five p atients were treated with interferon-alpha (IFN-alpha) without a demon strable effect on renal impairment, whereas five of 11 patients treate d with steroids showed improvement of the renal impairment. During the course of steroid therapy, the serum titer of HCV-RNA decreased in 5 of 7 patients. These observations suggest that HCV infection may be as sociated with several forms of glomerulonephritis. Type II HCV-RNA may have a strong association with MPGN in Japan. Steroid therapy is not contraindicated in patients with HCV-associated nephropathy if they ar e resistant to IFN-alpha treatment.